BACKGROUND OF THE CASE
• Patient R.A. was admitted to the
Cardiovascular Unit I of St. Luke’s Medical
Center on November 26, 2006.
• A diagnosis of Acute Coronary Syndrome was
made based on symptoms of chest pain,
elevated cardiac enzymes, and ECG findings.
• The patient received subsequent medical and
surgical management for this condition.
Reasons for choosing the case…
• At present, a large number of people observe unhealthy
practices or behaviors that contribute to the development of
ACS and other cardiovascular disorders.
• people may achieve a deeper understanding of the disorder
• a greater awareness of various exogenous and endogenous
factors which heighten the risk of developing ACS.
• prevention of the disease
• subsequent reduction in mortality and morbidity rates
resulting from ACS.
DEFINITION OF THE CASE
Acute Coronary Syndrome
• any group of clinical symptoms compatible with acute myocardial ischemia
• The initial diagnosis is based entirely on history, risk factors, and, to a
lesser extent, ECG findings.
• a set of signs and symptoms suggestive of sudden cardiac ischemia,
usually caused by disruption of atherosclerotic plaque in an epicardial
coronary artery.
• includes the symptoms of Unstable Angina (UA), Non-ST Segment
Elevation Myocardial Infarction (NSTEMI), and ST Segment Elevation
Myocardial Infarction (STEMI), commonly referred to as a heart attack.
• Primary prevention of atherosclerosis is controlling the risk factors:
healthy eating, exercise, treatment for hypertension and diabetes,
avoiding smoking and controlling cholesterol levels.
GENERAL SIGNS AND SYMPTOMS
Pain:
unstable angina
Cardiovascular Symptoms:
Palpitation, Jugular vein distention, S3 and S4,
Murmurs
Respiratory Symptoms:
Exertional dyspnea, Rales upon ausculatation
Gastrointestinal Symptoms:
Nausea
Musculoskeletal Symptoms:
Exercise intolerance
Integumentary System Symptoms:
Diaphoresis, cool clammy skin
Other (Emotional Symptoms):
Anxiety or a sense of impending doom
ETIOLOGY
Causes of ACS may be grouped into conditions
which:
A. Decrease Oxygen Supply
B. Increase Oxygen Demand
Decreased Oxygen Supply
• Atherosclerotic plaque
• Coronary artery vasospasm
• Embolic occlusion of the coronary arteries
• Hypoxia, as in carbon monoxide poisoning or acute
pulmonary disorders
• Cocaine and amphetamines
• Underlying coronary artery disease, which may be
unmasked by severe anemia
• Inflammation of epicardial arteries
• Coronary artery dissection
Increased Oxygen Demand
• Ventricular hypertrophy due to
hypertension
• valvular disease
• cardiomyopathy.
Risk factors for ACS
• Male gender
• Diabetes mellitus (DM)
• Smoking history
• Hypertension
• Increased age.
• Hypercholesterolemia and Hyperlipidemia
• Prior cerebrovascular accident (CVA)
• Inherited metabolic disorders
• Methamphetamine use
• Occupational stress
• Connective tissue disease
INCIDENCE
Frequency:
• In the US: Hospital discharge data indicate that 1,680,000 unique
discharges for ACS occurred in 2001.
• Internationally:
In Britain, annual incidence of angina is estimated at 1.1 cases per
1000 males and 0.5 cases per 1000 females aged 31-70 years.
In Sweden, chest pain of ischemic origin is thought to affect 5% of all
males aged 50-57 years.
In industrialized countries, annual incidence of unstable angina is
approximately 6 cases per 10,000 people.
Mortality/Morbidity:
• Before improved treatment for angina :
40% incidence of MI and a 17% mortality rate within 3
months.
• After improved treatment for angina :
A 47% relative decrease in 30-day mortality among newly
diagnosed ACS from 1987-2000. Clinical characteristics
associated with a poor prognosis include advanced age,
male sex, prior MI, diabetes, hypertension, and multiple-
vessel or left-mainstem disease.
• Sex: Incidence is higher in males among all
patients younger than 70 years.
• Age: In persons aged 40-70 years, ACS is
diagnosed more often in men than in women.
In persons older than 70 years, men and
women are affected equally
